Healthcare Provider Details

I. General information

NPI: 1548285703
Provider Name (Legal Business Name): SAMUEL N. OFORI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMUEL OFORI-NTOW M.D

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST SOUTH GEORGIA MEDICAL CENTER
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

PO BOX 70
VALDOSTA GA
31603-0070
US

V. Phone/Fax

Practice location:
  • Phone: 229-259-4689
  • Fax: 229-259-4601
Mailing address:
  • Phone: 229-259-4938
  • Fax: 229-259-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number060777
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number060777
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number060777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: